Finger, Hand and Wrist Injuries
Posted October 24, 2018
By Mackenzie Simmons, ATC
Athletic Trainers (ATs) are first responders for many patients who sustain finger, hand or wrist injuries during a sport or activity. Finger, hand and wrist injuries are extremely common in the active population, and often result in a trip to the emergency department or a primary care physician. These injuries are typically not life-threatening but can be extremely painful and limit mobility in the patient. Some conditions may require surgery, while others may result in immobilization or removal from activity. Below is a summary of common finger, hand and wrist injuries.
Finger and Thumb Injuries
Collateral Ligament Sprains
One of the most common injuries in sports are collateral ligament sprains of the fingers. This can occur at the metacarpophalangeal joint, the proximal interphalangeal (PIP) joint or the distal interphalangeal (DIP) joint. This injury typically occurs from jamming or stubbing a finger or tackling an opponent.
Signs and symptoms include pain, swelling, point tenderness, increased pain with stress and instability of the joint. With minor injuries to the ligament, a patient can be treated with buddy taping and return to play as tolerated. However, if there is an avulsion fracture with the injury, casting may be required and referral to a hand specialist may be needed for proper care and treatment.
Fractures and Dislocations
Two frequent finger injuries are fractures and dislocations. The mechanism of injury for these are similar to collateral ligament sprains. Fingers can be easily fractured or dislocated when a patient jams a finger into an object, or when the finger is caught in a facemask when tackling an opponent. The most common signs and symptoms include pain, swelling, ecchymosis, possible deformity and limited mobility. X-rays are recommended to assess the severity of the injury, and to ensure the patient will be able to return to play without worsening the injury. With a dislocation, the digit will need to be reduced to restore proper function to the joint. The treatment for this injury usually includes splinting or casting to immobilize the injured area; surgery may be used in extreme cases.
Jersey finger often occurs when an athlete grabs onto a jersey, and the other athlete pulls away too quickly. This causes an avulsion of the flexor digitorum profundus tendon off the distal phalanx. An avulsion fracture may also occur because of the force of this motion. As a result, the patient will be unable to flex the injured finger, and there may be some pain and swelling with this injury. Surgical intervention is most commonly used with jersey finger, and the patient can expect a minimum of 8 weeks without activity.
A mallet finger injury usually occurs when an object hits the finger, and the extensor tendon ruptures. Similar to jersey finger, an avulsion fracture may also happen due to forceful motion. The finger will droop noticeably and will look like it is in slight flexion. Other signs and symptoms may include pain, swelling and bruising. With nonsurgical treatment, a mallet finger is held straight in extension for 6-8 weeks and a splint must be worn at all times. Surgical treatment may be used if there is an avulsion fracture or if the patient is noncompliant with nonsurgical interventions.
A boutonniere deformity is another finger injury that can occur with the active population but is most commonly seen in an older population. This deformity affects the PIP joint, due to a tear in the central slip or to an inflammatory disease. As a result, the DIP joint hyperextends and will be unable to bend, and the PIP joint will be forced into flexion. Some signs and symptoms will be swelling, discomfort and obvious deformity. If surgery is not needed, a custom-made splint can be created to hold the splint in the position to promote healing. However, most cases of this injury require surgery.
Dupuytren’s contracture is a flexion deformity that occurs with a thickening of the palmar fascia. The cause of this injury is unknown, but it is commonly seen in the older population. If a patient has Dupuytren’s contracture, they will be unable to straighten the fingers completely, and usually affects the ring and pinky finger. If a patient is not experiencing serious complications, no treatment will be administered. However, if the deformity is causing issues with activities of daily living, there are several treatments that can be administered. Needling and enzyme injections can be used to break the cord of the tissue, freeing up motion in the fingers. Needling and enzyme injections are both minimally invasive procedures. Surgery may also be needed if the deformity is extreme.
Thumb Ulnar Collateral Ligament Tears
Thumb ulnar collateral ligament (UCL) tears are very common injuries, and occurs when there is a forceful abduction movement, such as falling on an outstretched hand while the thumb is abducted. The identifying signs and symptoms are pain, ecchymosis and swelling on the ulnar aspect of thumb. If there is a firm endpoint with valgus stress testing, the injury can be treated with immobilization with a thumb spica brace, splint or cast. However, surgery is recommended if there is no endpoint in this motion.
The scaphoid is the most commonly fractured carpal bone in the hand. This injury occurs when the hand is radially deviated and pronated with the wrist hyperextended, or by falling on an outstretched hand. Most patients will complain of wrist pain and might have mild swelling and decreased motion. If a scaphoid fracture is suspected, the fracture lines may not be present on an x-ray and may need an MRI. If the bone is non-displaced, it can usually be successfully treated by immobilization in a cast. However, if the fracture is displaced, surgical intervention will need to be used to ensure the bone heals properly.
Scapholunate Ligament Tears
The scapholunate ligament attaches the scaphoid and lunate bones together, which are located near the center of the wrist. Scapholunate ligament tears usually occur in sports that have a frequency of hyperextension, ulnar deviation and supination of the wrist. This injury may be hard to properly diagnose. However, the most common symptom is pain in a loaded, extended position. Other signs and symptoms may include snapping or popping in the wrist and swelling. An patient can be taped or braced if there is a partial tear in the ligament, but if there is a complete tear, wrist arthroscopy surgery will be needed.
Hook of the Hamate Fractures
Hook of the hamate fractures are usually caused by a direct blow and are frequently seen in patients who play sports that involve a racquet, bat or club. The main symptom of this injury is hypothenar pain, but the patient may also have weak grip strength. An MRI may be needed to diagnose this correctly as the hamate is a small bone. The most effective treatment is to have surgery to remove the hook of the hamate fragment that has been broken off; immobilization does not appear to have positive results with healing.
If a patient is diagnosed with a Bennett’s fracture, they have fractured the base of the first metacarpal bone. This fracture is caused by striking an object with a closed fist, and is common in boxing, football, rugby and soccer. Signs and symptoms include immediate pain, swelling, tenderness, visible deformity and some loss of movement. If the fracture is stable, the patient will be treated with a cast or splint, typically for 4-6 weeks. If the fracture is unstable, surgery will be needed to keep the bone in place without healing.
Triangular Fibrocartilage Complex Tears
Triangular fibrocartilage complex (TFCC) tears will present as ulnar-sided wrist pain. TFCC tears occur with hyperextension and pronation of the axially loaded, ulnar deviated wrist and by repetitive supination-pronation of the ulnar deviated wrist. Signs and symptoms include deep aching pain, clicking and pain with gripping. Immobilization may help reduce pain and allow the patient to rest, but surgical treatment can also be used when patients have recurring symptoms.
Carpal Tunnel Syndrome
Carpal tunnel syndrome is a common condition that results from compression of the median nerve. There are several factors that can cause this including overuse motions, bony protrusions into the tunnel and fluid retention. Carpal tunnel syndrome is most commonly seen in the older population and affects women more than men. The major signs and symptoms are pain, tenderness in the wrist, tingling, numbness and motor weakness. There are braces that can be worn to help alleviate the symptoms. However, in severe cases, surgery can be used to relieve the compression of the median nerve.
Synovial Cyst or Wrist Ganglion
A synovial cyst may also be called a wrist ganglion and is more common on the dorsal surface of the wrist. A wrist ganglion is caused by a herniation of synovial fluid, located in the joint capsule or sheath of a tendon. The major identifying sign of this condition is a palpable and observable mass on the wrist. Other symptoms include pain, restricted range of motion and tenderness. If the mass is small and does not cause any negative complications, a non-operative approach will be utilized. However, if the cyst is painful and restricting motion, a patient may undergo surgery.
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